Depressive disorders represent the main cause of disability in the world, due to its prevalence, its impact on the patient’s quality of life and its role as one of the main risk factors for suicide. Current antidepressant treatments can take weeks to take effect and months to achieve response and remission.It is estimated that up to 30% of patients with major depressive disorder (MDD) are resistant to antidepressant treatment, in addition, approximately 30-45% of patients with depression do not achieve an adequate response to the first antidepressant treatment.According to the STAR*D study, the more lines of treatment are required, the lower remission rates are estimated, as well as higher relapse rates during the follow-up phase.With the appearance of intranasal dosage esketamine allows the release directly to the central nervous system, the mechanism of action of esketamine is based on the antagonism of the NMDA receptor, which entails the modulation of the excitatory transmission of glutamate and the release of BDNF,activating neurotrophic signaling and synaptogenesis.

The objective is to expose the response after treatment with intranasal esketamine in a case of resistant depression.

A 55-year-old female patient, diagnosed with resistant recurrent depressive disorder.The patient had undergone treatment with different therapeutic lines with antidepressants, and potentiations with antipsychotics, observing little response in the current episode, for which reason we evaluated the indication of intranasal Esketamine. Scales: MADRS (Montgomery Asberg Depression rating scale) =37, Hamilton Depression Scale=25, PHQ-9=20, indicating severe depression.

After starting treatment with intranasal esketamine, an early response was observed. After the first month of treatment, mild depression was scored at MADRS=10 and moderate depression at Hamilton=14, PHQ-9=12, and at week 14 of treatment, it was scored mild depression in both MADRS and Hamilton. Intranasal 56mg esketamine plus 20mg escitalopram, 30mg mirtazapine and 5mg aripiprazole.

Intranasal esketamine offers a rapid reduction in depressive symptoms maintained over time, reducing the risk of relapse and with a favorable tolerability profile, so its use in depression resistant to treatment presents a great advance.

None Declared

Suicide is currently one of the biggest public health problems, it is the third cause of death in the age group between 15 and 29 years (16.36% of young people who died in 2013). The ‘Werther effect’ refers to the mimetic behavior of the suicidal act, thus making reference to the controversial novel “The Sorrows of Young Werther” by Goethe, in 1774. The population most susceptible to this influence is the most vulnerable and ambivalent, such as they can be adolescents and young people, people with personality disorders and drug use. Durkheim considered that imitation was not due to the contagion effect of making suicides public, but to the social conditions of some places, which were what caused people to commit suicide.

The objective of the case is to expose the vulnerability to the imitation of suicidal behaviors of young people suffering from personality disorder and drug use.

We present the case of 4 young people between 18 and 21 years old (3 women and 1 man) from the same group of friends who, after the death by suicide of a 20-year-old boy, in the following 2 months, carried out suicidal behavior by taking medication they found at home and consumption of different drugs.

The two 21-year-old patients planned for the first month of the anniversary of the friend’s death, the intake of drugs and medication and leave a farewell note explaining the reasons. The patients required hospitalization in an acute mental health unit, one patient developed myocarditis secondary to toxins, during hospitalization they undergo psychotherapeutic treatment and are evaluated, leading to the diagnosis of Borderline Personality Disorder and Multiple Drug Use Disorder. The 20-year-old patient took medication on the anniversary month but did not require hospitalization. He underwent outpatient follow-up at a day hospital. During the therapeutic process, he was diagnosed with schizoid personality disorder. The 18-year-old patient required hospitalization for structured self-injurious ideation with a risk of acting out at 2 months, psychotherapeutic treatment was started and she was diagnosed with borderline personality disorder and harmful drug use. The 4 young people continue outpatient follow-up by both the community mental health unit and the addiction treatment center.

We observe in the series of cases exposed, the vulnerability of young people suffering from personality disorders and drug use to suicidal behavior, so risk factors for their prevention must be identified and continue working on adequate information of suicidal acts, whether completed or not, to avoid imitation phenomena. In all cases, suicide should not be seen as a desirable alternative and strategies to cope with difficulties and emotional management should be offered and promoted, especially in this young population that is still developing and is more vulnerable.

None Declared

Stigma is a complex process and a universal phenomenon that is part of all social groups and that is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. The stigma of the patient is important to evaluate since it is a subjective experience that can have negative correlations in relation to self-esteem, empowerment and recovery orientation of the patient with mental illness. Hospitalization in mental health takes place at times of mental illness decompensation and is an intervention closely related to the stigma towards mental illness.

The objective of the study is to evaluate the stigma perceived by patients with mental illness hospitalized in an acute mental health unit.

Observational study with 53 patients hospitalized in an acute mental health unit.

Variables collected: Sociodemographic variables (age, sex), clinical diagnosis and stigma is evaluated with the Illness Self-stigma Scale (ISMI).

Sample of 53 patients, 55% women and 44% men, the most frequent diagnoses among those admitted are psychosis spectrum 26.42%, depressive disorders 24.53%, personality disorders 22.64% and bipolar disorders 11.33%. The average age is 41.96 years, between 18 and 72 years. The self-stigma according to the scale (ISMI) we obtain as a total score the patient with the highest stigma scores 100 points and the one with the least scores 44 points. Regarding diagnoses, depressive disorders score 33-72 points, while psychotic disorders score 36-85 points. The highest scores in self-stigma in our study are in personality disorders 49-100 and borderline personality disorder stands out (100 points). In the 5 subscales such as alienation, self-stigma, perceived discrimination, social isolation and resistance to stigma. Higher scores in alienation stand out in all patients.

Patients with personality disorders, especially borderline personality disorder, followed by psychotic disorders, present greater perceived self-stigma in our study than the rest of the patients; it is a very important factor that can affect the evolution of the clinical picture. This factor is important to establish the therapeutic plan and the different interventions, it would be recommended to assess the stigma together with the measures to reduce symptoms.

None Declared

The COVID-19 pandemic and social and mobility restriction measures have had a negative impact on the mental health of the population.

The objective is to demonstrate the impact of the pandemic on mental disorders.

64-year-old man who is taken to the emergency room after a suicide attempt, by hanging with a belt out of concern and measuring the contagion of the COVID-19 virus in the context of long-standing delirious ideas of contamination and hypochondriacal neurosis. Adaptive disorder in relation to previous divorce. Psychopathologically, the patient is anxious and restless, conscious, inattentive and poorly oriented in space and time. Accelerated language with monothematic discourse about the possibility of contagion that has caused isolation behavior to the point of shredding organic waste and throwing it down the toilet so as not to have to go out to throw it out for fear of contagion. Faced with a neighbor’s wake-up call due to a blocked pipe, he suffers a crisis of guilt and anxiety and attempts to commit suicide. COVID-19 PCR=negative. Beck’s Depression Inventory 24=moderate depression. IPDE accentuated obsessive and avoidant personality traits.

Diagnosis: Moderate depressive episode with psychotic symptoms. Hypochondriacal disorder. Ananchastic personality disorder. Treatment: Paliperidone 3mg/24h. Sertraline 100mg/24h

In obsessive personalities and hypochondriacal neuroses, the COVID-19 pandemic has posed an increased risk of decompensation for affective disorders and even suicide attempts. Isolation, lack of treatment and prior monitoring, as well as the difficulty of identifying vital stressors, must be taken into account if an early intervention is to be carried out.

No significant relationships.

Dyskinesias are motor disorders that occur as a side effect to treatment with typical and less frequently with atypical antipsychotic drugs. They are more frequents in child population. Treatment usually consists of decrease the dose of drug or replace it with a better profile tolerability antipsychotic. Clozapine is an antipsychotic drug indicated as second-generation treatment of motor disorders that appear as side effects to treatment with neuroleptics.

Demonstrate the efficacy and tolerability of clozapine in the treatment of dyskinesias in childhood.

The patient 12 year-old boy, has episodes of psychomotor agitation once a month. This will alternate with quiet moments in which dyskinetic movements are observed in upper limbs, without being able to detect any type triggering environmental factor. Personal history: hydrocele, diagnosed at 8 years becomes neurodevelopmental disorder considered. Neurosurgery tracking for Subarachnoid cyst. Psychopathological examination: Child presents psychomotor restlessness, disruptive behavior, impairments in communication, movement disorder, stereotypies and dyskinetic movements in shoulder and neck.

In the patient suffering from an autistic disorder, stereotypies and other motor symptoms were observed, the predominant and most relevant being dyskinetic movements in the shoulder and neck, which appeared one month after starting treatment with risperidone and worsening psychomotor skills. Treatment of dyskinesia with clozapine improved the motor symptoms presented by the patient.

Clozapine should be the treatment of choice in the event of dyskinesias as a secondary effect to other antipsychotic treatments, proving effective in controlling them as well as well tolerated in both adults and children.

No significant relationships.

The COVID-19 pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected.

The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19.

Patients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions “the virus has killed me, I’m already dead.” Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus.

After overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted.

Confusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis.

It is necessary to explore the possibilities of brief intervention of smoking cessation in bipolar disorder (BD) that may act on the level of motivation for change.

Assess the effectiveness of the 3 A's intervention (Ask, Advise and Assess) in a sample of euthymic BD patients.

260 patients diagnosed with BD that were in the euthymic phase and attended the Community care centers of Spain that have been evaluated for their history of smoking habits and current use.

Patients who consumed in the last month qualified for the level of motivation for change (measured by URICA scale); before and after conducting a brief intervention of no more than 30 minutes in total, divided in three contacts during a month, two face to face and one phone contact.

The 49% of the evaluated patients showed an actual use of cigarettes with an average of 28.73 (SD 11.82) years of consumption, with a mean consumption of 21.00 (SD 10.40) cigarettes per day and a level of nicotine dependency of 5.72 (SD 3.03). The 67% of patients were in the Contemplation stage of change, after the intervention 18% progressed to the stage of motivation and 14% ended up in the Stage of Ready for Change. In the third appointment the 21.4% of the smokers reported a reduction of the consumption.

The results seem to confirm its effectiveness, although it should be considered the possibility of carrying out specific tools of brief intervention for this sort of patients.

Jealous delusional ideation appears in 7-14% of cases of Parkinson's disease. Treatment with dopaminomimetics drugs is a significant risk factor for psychosis. However, the most likely etiology of psychosis in these patients is a loss of central cholinergic function associated with age since described psychosis even before the introduction of the L-Dopamine. Cognitive impairment and sleep disorders are predictors of development of psychosis.

Present a clinical case of psychosis in Parkinson's disease and its treatment.

Reason for consultation. Patient diagnosed with Parkinson's disease with behavioral disorder and delusional.

The patient after antiparkinsonian medication has increased suspicion, self-referentiality, delusional jealousy ideation to her husband, delusional interpretations regarding somatic symptoms, insomnia and behavioral disorders with aggression.

Mother with Alzheimer's.

No contact with mental health.

Conscious, repetitive language, dysphoric mood with delusions of prejudice and jealousy.

Mixed insomnia.

Psychosis in Parkinson's disease.

Quetiapine 300 mg/day. Carbidopa 25 mg/L-dopa 100 mg: 1-0-1. On subsequent visits quetiapine was suspended and replaced by clozapine 200 mg/day.

The treatment of psychosis was effective with the use of quetiapine and subsequently clozapine with good tolerance and effectiveness. He also said lower antiparkinsonian medication.

Psychotic symptoms are the most common psychiatric clinic in Parkinson's disease. Often not enough antiparkinsonian dopaminomimetics reduced to control psychotic symptoms and use of antipsychotics is required. The use of antipsychotics in Parkinson's disease should be careful for the likely increase in motor clinical and increased mortality. The most useful, are especially quetiapine and clozapine atypical antipsychotics.

The authors have not supplied their declaration of competing interest.